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Tara Lagu, MD, MPH; Nicholas S. Hannon, BS; Michael B. Rothberg, MD, MPH; Annalee S. Wells, DO; K. Laurie Green, MD; McAllister O. Windom, MD, MPH; Katherine R. Dempsey, BA, BS; Penelope S. Pekow, PhD; Jill S. Avrunin, MS; Aaron Chen, BS; and Peter K. Lindenauer, MD, MSc

The 1990 Americans with Disabilities Act requires equal access to health care for persons with disabilities. Investigators called 256 subspecialty practices in 4 cities to make an appointment for a fictional obese, hemiparetic patient who used a wheelchair and could not self-transfer to an examination table. Fifty-six practices could not accommodate the patient. Twenty-two practices had height-adjustable tables or lifts for transfer, but others reported the use of potentially unsafe transfer methods. These findings suggest that patients with impaired mobility encounter difficulty accessing care.

Topics: health services accessibility, americans with disabilities act, mobility, wheelchair
  
Irfan A. Dhalla, MD, MSc; Tara Gomes, MHSc; Zhan Yao, MD, MS; Jeff Nagge, PharmD; Navindra Persaud, MD, MSc; Chelsea Hellings, MSc; Muhammad M. Mamdani, PharmD, MA, MPH; and David N. Juurlink, MD, PhD

Some evidence suggests that chlorthalidone may be superior to hydrochlorothiazide for treating hypertension. This study of elderly patients found little difference between the 2 treatments in a composite outcome of death and hospitalization with heart failure, stroke, or myocardial infarction. However, patients treated with hydrochlorothiazide had fewer hospitalizations for hypokalemia. Hydrochlorothiazide in commonly prescribed doses may be superior to chlorthalidone for treating uncomplicated hypertension.

Topics: chlorthalidone, hypertension, hydrochlorothiazide (hctz), elderly, hypokalemia, hyponatremia
  
Karin Leder, MBBS, MPH, PhD; Joseph Torresi, MBBS, PhD; Michael D. Libman, MD; Jakob P. Cramer, MD, MSc; Francesco Castelli, MD, PhD; Patricia Schlagenhauf, PhD; Annelies Wilder-Smith, MD, PhD, MIH; Mary E. Wilson, MD; Jay S. Keystone, MD, MSc; Eli Schwartz, MD; Elizabeth D. Barnett, MD; Frank von Sonnenburg, MD, PhD; John S. Brownstein, PhD; Allen C. Cheng, MBBS, PhD, MPH; Mark J. Sotir, PhD, MPH; Douglas H. Esposito, MD, MPH; David O. Freedman, MD, for the GeoSentinel Surveillance Network*

International travel is rapidly increasing, as are travelers presenting with illness after they return home. Researchers used a large surveillance database to examine the frequency and patterns of illness in ill returned travelers. They found that diagnoses varied widely by destination and reason for travel and that serious diseases were reported even with travel to developed countries. Fewer than half of ill returned travelers had medical evaluations before travel, but illness from vaccine-preventable diseases occurred even in those who had evaluations before travel. These findings suggest opportunities for improving pretravel medical evaluation.

Topics: traveler, travel medicine, travel, surveillance, medical
  
M. Refik Gökmen, PhD, MA, MBBS; Jean-Pierre Cosyns, MD, PhD; Volker M. Arlt, PhD; Marie Stiborová, PhD; David H. Phillips, PhD, DSc; Heinz H. Schmeiser, PhD; Monique S.J. Simmonds, PhD; H. Terence Cook, MBBS; Jean-Louis Vanherweghem, MD, PhD; Joëlle L. Nortier, MD, PhD; and Graham M. Lord, MD, PhD, MA

Aristolochic acid nephropathy was first described 20 years ago, after an epidemic of progressive renal disease associated with consumption of Chinese herbs. The acid is associated with a high long-term risk for renal failure and urothelial cancer. This review describes the epidemiology of aristolochic acid nephropathy, its pathophysiologic basis and clinical presentation, and diagnostic criteria and management strategies to help better identify and treat patients.

Topics: urologic cancer, chinese herbs, aristolochic acid nephropathy, urothelial neoplasm, kidney failure
  

This U.S. Preventive Services Task Force updates its 2004 statement on screening for family and intimate partner violence. It recommends screening women of childbearing age for intimate partner violence and referring those who screen positive to intervention services. It also concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening all elderly or otherwise vulnerable adults for abuse and neglect.

Topics: domestic violence, elder abuse, spouse abuse, abuse, physical, elderly
  

This commentary discusses the political and practical obstacles over the next 4 years on the “road to health care reform” and describes how physicians in the United States can chart a path to a better health care system.

Topics: health care reform, patient protection and affordable care act, medicaid, medicare
  
David Blumenthal, MD, MPP

This commentary discusses the Office of Inspector General's recommendation that the Centers for Medicare&Medicaid Services (CMS) issue guidance concerning the documentation providers should keep to justify their meaningful use payments and that CMS conduct prepayment audits for at least some providers before dispensing payments. The CMS rejected the latter over concerns about undue burden on providers and delayed incentive payments, and many providers share these concerns.

Topics: health care financing administration, medicaid, medicare, electronic medical records, incentives, health information ...
  

In this issue, Lagu and colleagues found many physical access barriers in subspecialty practices for patients with mobility impairment. The editorialist discusses the study, as well as the findings in the context of the Americans with Disabilities Act of 1990, and suggests the use of adjustable-height examination tables, which can improve physical comfort, safety, and access.

Topics: physical examination, health services accessibility, disability, americans with disabilities act, mobility, wheelchair, ...
  
Christine Laine, MD, MPH, Editor in Chief; Darren B. Taichman, MD, PhD, Executive Deputy Editor; Cynthia Mulrow, MD, MSc, Senior Deputy Editor; Michael Berkwits, MD, MSCE, Deputy Editor for Annals and annals.org; Deborah Cotton, MD, MPH, Deputy Editor; and Sankey V. Williams, MD, Deputy Editor

The Editors discuss how physicians, who have long been powerful voices in discussions of issues that threaten public health, should draw on similar motivations and strategies to promote sensible, evidence-based laws to decrease the harms associated with gun violence.

Topics: firearms, violence, public health medicine
  
Lana R. Elpert, MD
Includes: Audio/Video

It was raining the morning that I met Mr. F. He looked out the window, and in a tone dripping with frustration he announced that it was his 32nd day in the hospital. He did not seem proud of this particular achievement.

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Charlie M. Wray, DO
Includes: Audio/Video

As I returned, instead of finding my patient, I found only his mother, sitting there alone. She shared her story with me as we sat together amidst the chaos. “I can't do it anymore, Doctor,” she said. “I'm too old for this.” I realized then that her son never really was my patient.

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Jeffrey J. Swigris, DO, MS; Kevin K. Brown, MD; and Amanda Belkin, MPH
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Noah Lechtzin, MD, MHS; and Maureen R. Horton, MD
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Julio Rosenstock, MD; Nikolaus Marx, MD; Odd-Erik Johansen, MD, PhD; Hans-Jürgen Wörle, MD, on behalf of the CAROLINA Steering Committee
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Erik A. Wallace, MD; John H. Schumann, MD; and Steven E. Weinberger, MD
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Philip E. Cryer, MD; Lloyd Axelrod, MD; Ashley B. Grossman, MD; Simon R. Heller, MD; Elizabeth R. Seaquist, MD; F. John Service, MD, PhD, on behalf of the Endocrine Society Task Force on the Evaluation and Management of Adult Hypoglycemic Disorders
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Nicholas J. Shaheen, MD, MPH; and David S. Weinberg, MD, MSc
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Brenda Butka, MD
Includes: Audio/Video
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Jack Coulehan, MD, MPH
Includes: Audio/Video
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Topics: aspirin, venous thromboembolism
  
Topics: chronic obstructive airway disease, amoxicillin-potassium clavulanate combination, obstructive airways disease, chronic, exacerbation, ...
  
Topics: tidal volume, mechanical ventilation, injury of lung
  
Topics: hetastarch, intensive care unit, mortality, fluid resuscitation, saline solution
  
Topics: gastrointestinal bleeding, upper, acute, mortality, transfusion
  
Topics: angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, kidney failure, chronic, diabetes mellitus, type ...
  
Topics: percutaneous coronary intervention, coronary artery bypass surgery, diabetes mellitus, type 2, mortality, ...
  
Topics: diabetes mellitus, type 1, hemoglobin a, glucose control, glucose measurement by monitoring ...
  
Topics: dehydration, hospice care, quality of life, parenteral administration, cancer, advanced
  
Topics: antibiotics, glucocorticoids, pain management, sore throat
  
Topics: ischemic stroke, selective serotonin re-uptake inhibitors, disability
  
Topics: anticoagulants, oral, hemorrhage, risk of excessive or recurrent bleeding
  
Topics: health services accessibility, wheelchair, mobility
  
Topics: domestic violence, elder abuse, spouse abuse, abuse, physical
  
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